“Suraksha” for the perpetual protection of our children….

We are now in front of a promising approach. In the history this type of stories were heard very rarely. This kind of a welfare project is launched for the first time not only in Sri Lanka but for the first time in South Asia.
 

The Ministry of Education under the directions of The Minister of Education Akila Viraj Kariyawasam has started health insurance scheme covering all school children in the country. The insurer is the Sri Lanka Insurance Cooperation. All school going children of you and us between the ages of 05 to 19 have been covered under this insurance scheme. The insurance is launched under the theme of ‘Let’s Protect Our Children Perpetually”. It has been named as “Suraksha students insurance”.

There are forty five hundred thousand school children in our country. They learn in 11242 schools. Nearly forty five hundred thousand students between the ages of 05 to 19 studying in government schools, assisted private schools, non-assisted private schools, international schools and the student monks in Pirivenas have become instantly the beneficiaries of this insurance. All of them have been compulsorily registered in this insurance. All data files of them are being prepared at the moment.

No initial payments…..

The parents of these children will not have to pay any amount regarding this insurance; all the payments for Suraksha student insurance will be borne by the government. Initially under the 2017 government budget proposals Rupees 2.7 billion has been allocated for this insurance. The insurance organization is the Sri Lanka Insurance Cooperation. In an event of insuring, the insurance company is entitled for a legal amount of commission. Using that money, an additional fund is scheduled to be opened according to a request made by The Minister of Education Akila Viraj Kariyawasam. That fund is scheduled to be functioned just as the Presidential fund that provides financial assistance for diseases like Cancer, Marrow transplant and special surgeries those are not covered by the insurance.

How the benefits are received from the insurance…..

Annual insurance cover for residential patients and the provision of medical services is rupees two hundred thousand. For one occasion of hospitalizing a child, expenses up to one hundred thousand will be reimbursed. The insurance has provided the opportunity to reimburse the medical charges for medical tests even without hospitalization of a child. The insurance cooperation issues a card for each child covered by the insurance. The beneficiary must submit this card when he receives treatment. The insurance has based initially the government hospitals and government medical service. But the insurance cover is provided even when any private hospital registered under the Ministry of Health or an Ayurvedic hospital is selected for treatment.

Obtaining treatment from a government hospital….

When residential treatment is obtained from a government hospital, payments are made per thousand rupees a day maximum thirty days in a year. Furthermore, for the tests obtained from outside while being under residential treatment in a government hospital, there is insurance cover up to ten thousand rupees.

Obtaining treatment from a private hospital…..

If the treatments are taken from any private hospital registered under the ministry of health, a maximum payment of one hundred thousand will be made. As a result of a discussion made by the minister of education with the association of private hospital owners and the association of specialist doctors, it has been agreed to give twenty per cent rebate for hospital charges and the charges of specialist doctors for the children taking treatment under the Suraksha students insurance.

Providing medical services for the children having residential care….

When a child admits to a private hospital, a paying ward in a government hospital or an Ayurvedic hospital charging fees, maximum payment for a room is five thousand rupees per day. The annual maximum payment is sixty thousand rupees.

There are criteria for medical payments too. Payment for the doctors with MBBS, DAMS or other higher qualifications is maximum thirty thousand rupees for one hospitalization. The annual maximum payment is sixty thousand rupees. The payment for various hospital services such as medicine, different kinds of drugs, surgical charges and special treatments is forty thousand rupees for one hospitalization. The annual maximum payment is eighty thousand rupees.

When not admitted to a hospital….

This insurance provides the opportunity to have the insurance cover for treatments and doctors’ fees without hospitalization also. There is a maximum annual cover of ten thousand rupees for the outdoor treatments for seven illnesses. Those diseases are special illnesses with life threats. For covering the expenses for medicine and clinical tests in relation to cancer, last stage kidney failures, transplant of main organs, paralysis, blindness, multi … and third range burnings can be covered up to ten thousand rupees.

Other coverings…

If a child is dead in an accident, the compensation will be one hundred thousand rupees. If the parents of the child are dead (only for one person) the amount provided for the continuation of his studies is seventy five thousand rupees. If a child becomes totally invalid (including full blindness, losing two limbs, losing one limb, losing one eye) the compensation paid is one hundred thousand rupees. Compensation for half invalid condition is fifty thousand rupees.

Occasions not covered by the insurance….

When receiving residential treatment in a private hospital the registration fee will not be covered by the insurance. Discussions are being held for covering that occasion also. When the room charge is exceeding five thousand rupees per day, that amount must be borne by the insured. VAT will be charged when the sub field limit is exceeding.

The insurance cover will not be given to the insured for the acute diseases he had prior to obtaining this insurance. The acute diseases of invalid children by birth are not covered by the insurance. Payments are not done for the hospitalizations without a recommendation of a doctor and for the treatments without a certification from a qualified doctor. The insurance is not liable for the treatments done by the doctors not having the government approval. The insurance is also not liable for plastic surgeries, beauty therapies, treatments for reducing weight, hospitalizing only for diagnosis without treatments, deaths or permanent disability in a natural disaster, medical treatments obtained outside the country, claims made by the children beyond the age limit, venereal diseases and accidents happening due to the use of alcohol.

This insurance scheme has been prepared following the basic conditions applied in any insurance scheme made with any insurance company in the world. Our children will be protected from today under those conditions.

We had been unsafe severely as a country and had been helpless people. Sometimes we had been such worthless people. It is a real luck to be able to keep a special step as a nation to protect our children in such a society with numerous challenges.